We need to tell the truth about ‘bed blocking’

The term is pejorative – laying the blame for a problem at the door of the victims left to languish in hospital because they can’t be safely discharged

James Moore
Thursday 05 January 2023 17:00 GMT
'Intolerable' NHS pressures show little sign of relenting, government warned

Did you know that London’s biggest hospital is St George’s in Tooting? Per its website, it has something over 1,300 beds. There’s a reason for my mentioning St George’s. Data put out by NHS England shows that at the end of November, something over 13,000 people who “no longer meet the criteria to reside” in hospital were still occupying a bed.

You don’t need to be one of the teenagers forced into one of Rishi Sunak’s maths lessons (goodness knows who’s going to teach them) to be able to work out that keeping the equivalent of 10 super-hospitals full of people who are healthy enough to be sent home with the right support represents a huge, and very costly, problem for the NHS.

Similar problems are at work in Scotland, Wales and Northern Ireland. The phenomenon of people who “no longer meet the criteria to reside” is sometimes described as “bed blocking”. That’s a term I struggle with because of its pejorative nature. It lays the blame for a problem created by a lack of resources along with government and multi-agency failings at the door of the victims left to languish in hospital because they can’t be safely discharged.

These are people who need some level of assistance to safely go home, which is where they would much rather be. For all the undoubted dedication of their staff hospitals are noisy, unhealthy, uncomfortable and invariably stressful for patients. No one wants to stay in one for any longer than is necessary. But that assistance can be very hard to obtain.

This is where the problem of resources – and the government’s failure to provide them – comes in. According to a House of Lords report last month, the NHS had 133,446 vacancies, a rate of 9.7 per cent. This is an oft-quoted figure. Less often seen is the fact that out of 1.79 million adult social care posts, 165,000 had also been left unfilled, a rate of 9.2 per cent.

The similarity between the two is striking. Of course, both sectors suffer from poor pay, outsized workloads (partly as a result of the vacancies) and often shoddy conditions. Both also suffer from a government that appears wilfully blind to the problems they face. Solving the vacancy crisis in the case of social care – necessary to free up beds – would appear to be more complex than in the case of the NHS, where agreeing a fair pay settlement with unions would be your starter for ten.

Social care is provided by a diffuse network of operators, sometimes public, sometimes private. The latter often actively discourage unionisation. But an industry-wide fair pay agreement, of the type advocated by the TUC, would go a long way towards helping matters.

The issue of poor conditions could, meanwhile, be addressed by the imposition of minimum standards. A few more work visas wouldn’t go amiss, either. We have a nationwide labour shortage. Growling about immigration isn’t going to solve it. Happier and better-paid staff wouldn’t end the problem.

This brings us to those inter-agency failings. My colleague Alastair Jamieson recently wrote movingly of how his cancer-stricken father was left to die alone and unnoticed in hospital, a place “where he shouldn’t have been”.

It isn’t solely down to a lack of resources that keeps people in hospital when they should be out. Accessing what help there is available and navigating the discharge process often requires people wade through a bureaucratic swamp.

As Jamieson wrote: “We must also improve the ways in which hospitals and care services work together to get patients off busy wards, and into places where they belong. Sometimes that is not a matter of resources, but of common sense and basic care.”

Absolutely. And isn’t that where government once again comes in? We elect our leaders to identify, investigate and then solve these problems. They are not doing that. They don’t even appear to be trying. They instead prefer to talk over them. The way they misuse statistics to claim that black is white and things are better than they are is maddening. When politicians make claims at odds with people’s lived experience it only adds to the contempt in which government is held.

Note to Sunak: in addition to mandating those maths lessons, you promised to address the issue of NHS waiting times in your big New Year speech. You simply aren’t going to do that unless the lobster traps hospitals often turn into are opened up to allow people to go home.

That, I’m afraid, is going to take money. But overhauling the way discharges are handled and agencies interact with each other is also required. So, Sunak, get on with it. Put a rocket up the backside of your hapless health secretary Steve Barclay. Or just move him. Otherwise, those waiting lists will only grow and there will be more avoidable and unconscionable tragedies like the one that affected the Jamieson family.

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